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Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and e...

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Autores principales: Lemoine, M, Obergassel, J, Rottner, L, Moser, F, My, I, Wenzel, J P, Moser, J, Reissmann, B, Ouyang, F, Kirchhof, P, Rillig, A, Metzner, A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206950/
http://dx.doi.org/10.1093/europace/euad122.083
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author Lemoine, M
Obergassel, J
Rottner, L
Moser, F
My, I
Wenzel, J P
Moser, J
Reissmann, B
Ouyang, F
Kirchhof, P
Rillig, A
Metzner, A
author_facet Lemoine, M
Obergassel, J
Rottner, L
Moser, F
My, I
Wenzel, J P
Moser, J
Reissmann, B
Ouyang, F
Kirchhof, P
Rillig, A
Metzner, A
author_sort Lemoine, M
collection PubMed
description FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and efficacy, long-term PVI durability and reconnection patterns are unknown. Here, we analyzed findings from repeat ablation procedures after index PFA compared to cryoballoon ablation (CBA) based PVI. METHODS: We prospectively included consecutive patients with index PVI applying PFA (n=161) or CBA (n=302) who underwent repeat ablation due to symptomatic recurrence of AF or atrial tachycardia (AT) after a blanking period of 3 months. All repeat procedures were performed with a 3D mapping system and RF energy. RESULTS: We identified a total of 14 patients after previous PFA and 23 patients after previous CBA. PV reconnection was detected in 9/14 (64%) patients after PFA and in 16/23 (70%) after CBA (p=1.000). A total of 24/55 (44%) vs. 34/92 (37%) initially isolated PVs demonstrated electrical reconduction (p=0.487) after PFA and CB ablation. In both groups the right inferior PV was reconnected most frequently (9/24 (38%) patients after PFA and 10/34 (29%; p=0.578) patients after CBA). Distribution of conduction gaps is shown in figure 1. All PVs were successfully reisolated. Repeat procedures after index PFA and CBA showed similar duration (115±32 min vs. 114±49 min; p=0.785), fluoroscopy time (13±4 min vs. 14±8 min; p=0.558) and number of RF applications (38±23 vs. 36±34, p=0.738). CONCLUSION: During repeat AF/AT ablation after previous PFA- or CBA-based PVI a comparable incidence of PV reconduction gaps was found. Repeat procedure times and fluoroscopy exposure were similar. Randomized controlled trials and longer follow-up are necessary to draw further conclusions. [Figure: see text]
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spelling pubmed-102069502023-05-25 Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation Lemoine, M Obergassel, J Rottner, L Moser, F My, I Wenzel, J P Moser, J Reissmann, B Ouyang, F Kirchhof, P Rillig, A Metzner, A Europace 10.4.5 - Rhythm Control, Catheter Ablation FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and efficacy, long-term PVI durability and reconnection patterns are unknown. Here, we analyzed findings from repeat ablation procedures after index PFA compared to cryoballoon ablation (CBA) based PVI. METHODS: We prospectively included consecutive patients with index PVI applying PFA (n=161) or CBA (n=302) who underwent repeat ablation due to symptomatic recurrence of AF or atrial tachycardia (AT) after a blanking period of 3 months. All repeat procedures were performed with a 3D mapping system and RF energy. RESULTS: We identified a total of 14 patients after previous PFA and 23 patients after previous CBA. PV reconnection was detected in 9/14 (64%) patients after PFA and in 16/23 (70%) after CBA (p=1.000). A total of 24/55 (44%) vs. 34/92 (37%) initially isolated PVs demonstrated electrical reconduction (p=0.487) after PFA and CB ablation. In both groups the right inferior PV was reconnected most frequently (9/24 (38%) patients after PFA and 10/34 (29%; p=0.578) patients after CBA). Distribution of conduction gaps is shown in figure 1. All PVs were successfully reisolated. Repeat procedures after index PFA and CBA showed similar duration (115±32 min vs. 114±49 min; p=0.785), fluoroscopy time (13±4 min vs. 14±8 min; p=0.558) and number of RF applications (38±23 vs. 36±34, p=0.738). CONCLUSION: During repeat AF/AT ablation after previous PFA- or CBA-based PVI a comparable incidence of PV reconduction gaps was found. Repeat procedure times and fluoroscopy exposure were similar. Randomized controlled trials and longer follow-up are necessary to draw further conclusions. [Figure: see text] Oxford University Press 2023-05-24 /pmc/articles/PMC10206950/ http://dx.doi.org/10.1093/europace/euad122.083 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle 10.4.5 - Rhythm Control, Catheter Ablation
Lemoine, M
Obergassel, J
Rottner, L
Moser, F
My, I
Wenzel, J P
Moser, J
Reissmann, B
Ouyang, F
Kirchhof, P
Rillig, A
Metzner, A
Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title_full Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title_fullStr Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title_full_unstemmed Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title_short Pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
title_sort pulsed-field ablation based pulmonary vein isolation: reconnection pattern and comparison to cryoballoon ablation
topic 10.4.5 - Rhythm Control, Catheter Ablation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206950/
http://dx.doi.org/10.1093/europace/euad122.083
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